Seven states and a group of pediatricians are suing President Joe Biden’s administration over a rule that would force doctors to provide sex-change procedures and require health insurers to cover them.

“Joe Biden is once again exceeding his legal authority in order to force his radical transgender ideology onto the American people,” Missouri Attorney General Andrew Bailey, who led the seven-state coalition, said in a statement on Wednesday.

The lawsuit argues that the Department of Health and Human Services (HHS) did not have the authority to create the rule and that it is not a legitimate interpretation of the Affordable Care Act’s prohibition on sex discrimination. It also argues that the rule violates the First Amendment and Fifth Amendment rights of health-care providers.

The Biden administration “is threatening to hold federal funding hostage from any health care provider that refuses to perform or affirm harmful and irreversible transgender procedures,” Bailey said.

“I am filing suit because I will not allow out-of-touch federal bureaucrats to force Missouri health care providers into performing experimental and dangerous gender-transition procedures on the taxpayer dime.”

The other states joining in the lawsuit are Arkansas, Idaho, Iowa, North Dakota, South Dakota and Utah.

HHS issued the rule in April of this year. The rule reinterprets the Affordable Care Act’s (ACA) prohibition on “sex” discrimination to include a ban on “gender-identity” discrimination, even if the person’s self-asserted “gender identity” is different from his or her sex. The ban on discrimination applies whether the patients are adults or minors.

Refusing to provide or cover transgender medical interventions, such as sex-change operations and drugs, is considered discriminatory and unlawful under the rule. If a health provider or insurer violates this rule, they could be stripped of federal financial assistance and would be excluded from participating in Medicare and Medicaid. 

The ACA itself does not specifically reference “gender identity” or sex-change procedures on adults or minors.

The lawsuit asks the federal court to block HHS from enforcing the law against the seven states in the lawsuit and the doctors affiliated with the American College of Pediatricians, which is also represented in the lawsuit. 

Last week, a federal judge temporarily blocked HHS from enforcing the law against 15 other states who separately filed a lawsuit.

Dr. Jill Simons, the executive director of the American College of Pediatricians, said in a statement that the organization joined the lawsuit because “doctors should never be forced to violate their sound medical judgment and perform life-altering and sterilizing interventions on their patients.”

“Our doctors take an oath to do no harm, but the Biden administration’s rule forces them to violate this oath and perform procedures that are harmful and dangerous to our patients — vulnerable children,” she added. “What the Biden administration is calling for is wrong and unlawful.”

Alliance Defending Freedom (ADF) Senior Counsel Julie Marie Blake accused the Biden administration of trying to “hijack medicine” with the rule. ADF is representing the American College of Pediatricians in the suit.

“The HHS rule will harm those suffering from gender dysphoria, particularly children, and punish doctors who seek to care for them,” Blake said in a statement. 

“Medical professionals around the world and individuals who have undergone these experimental, body-altering procedures are warning about their risks,” she said. “Yet the Biden administration is working to force doctors to perform these harmful, often sterilizing procedures to make people appear as the opposite sex.” 

“We are urging the court to halt the administration’s vast overreach in health care.”

The HHS did not immediately respond to a request for comment.